Provider Demographics
NPI:1215027685
Name:JOHNSON, CATHERINE VICKERS (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:VICKERS
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 SHALLEY DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-3019
Mailing Address - Country:US
Mailing Address - Phone:850-893-5720
Mailing Address - Fax:
Practice Address - Street 1:107 REGIONAL REHABILIATION CENTER
Practice Address - Street 2:FLORIDA STATE UNIVERSITY
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32306
Practice Address - Country:US
Practice Address - Phone:850-645-7303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1287231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist